Never thought about in being in all my medical records everywhere.
Too late now I guess as his assistant took the list from me to
put in my file.
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I donāt tell my doctor that I take rapamycin but I did tell him I take metformin for longevity. He was fine with that. I donāt take any doctor prescribed drugs so interactions with prescribed drugs is not an issue.
My sister-in-law, who is an MD, told me not to tell doctors that I take self prescribed drugs for off label use. She said I should think of them as supplements. I tried to convince her to take rapamycin but she has not been interested. She is 64 years old while my wife is 70 and I am 71.
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I had a blood test done. My lipids are through the roof and my glucose is elevated. Iām slightly concerned. I told my doctor ahead of time iām on rapamycin. If not, the results would be very alarming. Canāt really hide the effects.
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To be fair, there are real risks with taking supplements to the point where a case-by-case is prudent. I see too many inexperienced people jump to supplements or prescription drugs without much thought based on āhealth gurusā - ie Ivermectin or multivitamins. The physician has no idea if the patient falls into the category of āI read it on Dr. Google and my headache is related to brain cancerā.
The only exception I see is when the prescriber is following principles of off-label prescription/supplemental adjuvants and has experience, on top of deep research experience.
For example, my psychiatrist was very much open to psilocybin for GAD and adjuvant PUFA dietary supplementation (plenty of evidence that it is clinically significant in my situation).
See Cochrane:
āNone of the treatments compared with placebo have shown a difference in the risk for lung cancer incidence or lung cancer mortality in healthy people. In smokers and people exposed to asbestos, vitamin A increases lung cancer incidence, lung cancer mortality and all-cause mortality. Vitamin C increases lung cancer incidence in women. Vitamin E increases the risk of haemorrhagic strokes.ā
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The short of it in my situation - I would tell an ER doc my situation, based on what is pertinent. If Iām incapacitated, confused, or lack capacity - my concierge PCP knows what to do already.
Heās pretty much read most of what I offered - but I suppose thatās because he quickly saw the strength of the evidence I presented such as say psilocybin when I mentioned clinical trial evidence to help his GAD.
This would be a challenge if one does not know what is medically pertinent.
Very similar to information asymmetry theory:
Now Iād also beware of urgent care and ED issues when they are often stacked full of non-physicians:
Just today, a bud of mine from a top radonc program:
āSo sir, you know why urology sent you here?ā
āNope, my PSA is in good rangeā
āWell technically yes, but except for the fact that you had your prostate removedā¦. Your PSA should be close to 0ā
āWait what?!ā
āWhoās your urologist?ā
mentions name
Itās a PA smh
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"Heās pretty much read most of what I offered - but I suppose thatās because he quickly saw the strength of the evidence I presented "
I tried that once with my doctor and it really pis**d him off. I have found in general throughout my life that doctors are not very open to suggestions. Somehow they think you are questioning their expertise.
My doctor is a good man, but in his eyes, he is always the authority and I of course am just a layman. Since you are a doctor, I am sure this factors into your psychiatristās decision to listen to your suggestions.
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Perhaps thatās a big factor (Iām just much more likely to spend more time hearing out a colleague on research matters) - but personally, I donāt play psychiatrist - I just go straight to the point when it comes to presenting evidence and keep to the circle of knowledge I am familiar with.
For example, FDA breakthrough therapy designation for psilocybin and CHADD DHA/EPA meta-analysis. Pretty concisely communicates itās worth looking at to my psychiatrist or a general physician if he doesnāt already know about it.
I think the problem is in part what I mentioned earlier:
āThe physician has no idea if the patient falls into the category of āI read it on Dr. Google and my headache is related to brain cancerā.ā
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Oh and another issue is the average physician in a PCP capacity has 5-10 min per patient due to the non-physician bean counters who push certain patient volumes (ie private equity firms). They probably have no time to read anything you give them.
Thatās why I would never go see a regular clinic (with minor exceptions when availability is an issue). A concierge PCP with demonstrated open mind, research experience, and critical thinking is my go-to. The average patient gets 35 min.
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My own experience is: The higher the dose, the higher the lipids. What is your dose regimen? Maybe you need to back off a little.
Dr. Mikhail Blagosklonny suggests pulse dosing, increasing the dose until you start to see adverse side effects then back off. Maybe much higher than normal lipids is an adverse side effect.
I am currently taking a break from rapamycin. When I start again it will be with a lower dose, then I will increase the dose slowly while keeping track of my lipids.
I never saw any effect on my glucose levels at any dose.
You can get food drug interactions (classic GFJ is the perfect example) or supplement drug interactions.
Fortunately, I have zero health issues other than age. I have no problem trying or getting the supplements or drugs that have some health benefits as supported by good trial evidence and are considered relatively safe.
To be honest, I donāt think very many doctors including concierge doctors really keep up to date on the latest longevity findings, especially when it comes to supplements. I happen to live in a city where we have more than our fair share of concierge doctors. Color me skeptical, but I see them as seeking higher incomes. I happen to know one personally through an organization that I belong to and that is certainly the case with him.
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Depends on why you would have one.
For example, the copay on routine labs is way cheaper than via insurance. Clear money saver in my situation any way you cut it.
Another thing is my SO can call anytime so he can coordinate with ICU if I end up there. If you have ever seen anyone in the ICU, they often have incomplete information - itās all siloed up. My PCP has it all in one place and is familiar with drug interactions.
If I need to bypass āsubpar triageā in ED, he has the connections, so I am pretty much guaranteed a quick hospital bed if I need one. Speed and availability can count if you watched COVID play out.
Ultimately the main benefit is whether you think paying for access to extra time is worth it or not. Older patients are often way more complex, but plenty of geriatricians are hiding their credentials to make more as a GP. Iāve seen enough āfactory medicineā, āmissesā and ānear missesā to know itās not worth skimping on for my situation and risk tolerance.
Concierge medicine isnāt necessarily higher income btw. That really depends on how many subscribers they have. I know a few really good ones that will only take so much and stop accepting new patients instead of ones that will farm it out to NPs for more income. You will find those are almost always not taking anyone new.
Iām pretty sure theyāre making less than what they could have based on the numbers. But theyāre generally happier when it comes to a lack of BS back and forth with insurance. That BS eats up a lot of physician time.
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You are correct!
Very few if any physician who see patients are aware about the ālatest longevity findingsā.
They reality is they are more interested in medical economics.
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Unfortunately true more often than not.
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I think your two points are somewhat conflicting with each other here. Let me elaborate.
Any longevity finding that is proven even to a modest effect translates into trillions of dollars globally in terms of productivity and is directly related to medical economics. Longevity in terms of increased ādisability-adjusted life yearsā makes the most sense as one of the highest priorities in medical economics. Iād say Iām very familiar with medical economics, but not many of my colleagues are - which is partly why ālongevityā is not really high up on priority reading for most of my colleagues.
Some healthy amount of skepticism is good. But it sounds like youāre being a bit too skeptical about physicians based on personal anecdote - when many are just a cog in the wheel. The problem is not a focus on medical economics on the physician end. A lot of physicians genuinely donāt even know how billing works or literally how much youāre being charged. Feel free to ask your own physician or physician friends and test this out. Iām telling you many docs are literally bad at finance and economics, let alone medical economics. The poor financial literacy rate in official statistics is quite telling.
Seeking higher incomes is a common incentive in any field - Iām not saying all doctors arenāt driven by financial incentives, but itās the private equity firms and hospital bean counters that determine income levels and design the financial incentives - thatās what I meant by āfactory medicineā. Academic medicine, on the other hand, translates to much lower incomes but is quite popular as well - clearly, not all physicians are incentivized by income. Let me ask you - do you really want to play into the hands of private equity giants by buying into āfactory medicineā market consolidation run by experts at medical economics in private equity firms like everyone else?
As for ālatest longevity findingsā - itās usually not a priority to read up on literature that is not even up to a āweak recommendationā level of evidence - thatās what the latest āfindingsā are. And there are plenty of reproducibility issues in science generally so thereās no incentive to read through something that might be not real. The reproducibility crisis is so bad that the āgold standardā is the NIH/NIA ITP to date and has shown there are quite a few high-profile duds pushed as the latest longevity findings. And thatās a tiny subsection of the latest findings that were convincing enough to test.
As for those who are keeping up - there are plenty of continuing medical education courses for physicians in āLongevity Medicineā, āPrecision Medicineā, etc. Itās a matter of whether they are open-minded, view it as a priority, and are experienced in research methods enough to figure out whatās actually worth looking at. You wonāt find that in āfactory medicineā where they are looking to check all the boxes.
If you thought Big Pharma had huge profit incentives, you should look at something thatās huge and even more profitable in terms of CAGR:
There are plenty of real quality control problems in the supplement industry as a whole and there are plenty of quacks out there much greedier than Big Pharma with lack of regulation. If I wanted to make tons of money as a physician - selling the equivalent of āpenis enlargement pillsā is one of the best ways to go - instead of opening a concierge clinic with a limited number of patients and not farming out to NPs.
Iāll also point out that most physicians are not up-to-date on nutrition. The main problem I see is the large number of patients swayed by āhealth gurusā on a Google search for unproven or even worse, disproven supplements. So I can see why many physicians become wary of supplements when they see that way too often. As mentioned previously, there is āhigh certaintyā evidence to show certain vitamin supplements can increase cancer in specific but fairly common situations. But Iāve seen way too many folks think vitamin supplements must equal safe.
Try to put yourself in our shoes:
āThe physician has no idea if the patient falls into the category of āI read it on Dr. Google and my headache is related to brain cancerā.ā
How would you know whether a patient is in that category if you only had 5-10 minutes to see them? You donāt! You just focus on what matters the most in āfactory medicineā, as expected. Check all the standard boxes and skip the rest.
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Dosage likely the cause. I was on 10mg ever 2 weeks. I also took my lipid test 2 days after taking rapa. Iām now switching to 9mg ever 3 weeks now. I took a 1month break from it after my tests.
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In my experience at a PCP, the whole āpreventionā regimen consists of doing a lipid panel and then prescribing a statin if the cholesterol numbers are too high. The attitude to vitamins and supplements is āoh yeah go ahead and do that if you want, it doesnāt really do anything though.ā Anything they say about diet will be actively counterproductive (and since many of them are fat, why even ask them about diet because they obviously donāt know what works). I think theyāve given up on recommending exercise because most people just wonāt do it.
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Yeah.
All pretty much true Iām afraid.
Not much more to be said.
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The good thing about my primary care doctor, is he lets me do whatever the hell I want to.
But seriously, thereās no reason to mention it any medical professional. If anything, it will cause them to freak out.
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As I have posted before, my cardiologist dropped me like a hot potato when I tried to talk to him about rapamycin and immediately referred me to another cardiologist. So, not medical advice, but probably keep mum about rapamycin.
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